Abst Meta Analysis Of The Curative Effect Of Carotid Endarterectomy And Carotid Stenting In The Treatment Of Carotid Artery Stenosis

【Objective】To evaluate the clinical efficacy of endarterectomy and stent placement in patients with carotid artery stenosis,and to conduct a Meta system analysis on it.【Methods】Search CNKI,Wanfang,Weipu,China Biomedical Literature Database,Web of scicence,PubMed,EMBASE database and manually search related documents.The search period is from January 2010 to February 2021.According to the Cochrane systematic review methodology,data extraction and quality evaluation of the included literature were carried out,and the RevMan5.3 software was used for meta-analysis.【Results】This study included 23 related literatures on the treatment of carotid artery stenosis,all of which were randomized controlled trials,with a total sample size of 31153 cases,19389 cases in the CEA group,and 11,764 cases in the CAS group.The results of the meta-analysis showed that the P values of mortality within 3 months after operation,mortality after 1 year,stroke rate after 1 year,and incidence of restenosis were all<0.05,the difference was statistically significant;stroke occurred within 3 months after operation The P value of the incidence rate and the incidence of myocardial infarction and the incidence of myocardial infarction after 1 year were all> 0.05,and the difference was not statistically significant.The analysis results showed that the 3-month mortality rate in the CEA group was significantly lower than that in the CAS group,[OR=0.62,95%CI(0.42,0.93)Z=2.33,P=0.02].The incidence of stroke at 3 months in the CEA group was higher than that in the CAS group,[OR=1.23,95%CI(0.49,3.10)Z=0.44,P=0.66].The incidence of myocardial infarction at 3 months in the CEA group was higher than that in the CAS group,[OR=1.60,95%CI(0.93,2.75)Z=1.70,P=0.09].The mortality rate after 1 year in the CEA group was significantly higher than that in the CAS group,[OR=0.79,95%CI(0.68,0.92)Z=3.05,P=0.002].The stroke rate in the CEA group was lower than that in the CAS group after 1 year,[OR=0.71,95%CI(0.60,0.82)Z=4.40,P<0.00001].The incidence of myocardial infarction after 1 year in the CEA group was lower than that in the CAS group,[OR=0.89,95%CI(0.76,1.04)Z=1.45,P=0.15].Although the incidence of restenosis in the CEA group was lower than that in the CAS group,the difference was not statistically significant,[OR=0.94,95%CI(0.79,1.13)Z=0.64,P=0.52].The incidence of postoperative brain complications [OR=4.76,95%CI(1.24,18.21)Z=2.28,P=0.02];the incidence of cardiovascular complications [OR=1.39,95%CI(0.43,4.51)Z =0.66,P>0.05];the incidence of local complications [OR=1.85,95%CI(1.24,2.76)Z=3.03,P=0.002].【Conclusion】The mortality rate of CEA group and the incidence of stroke 1 year later was lower than that of CAS group within 3 months after operation.The mortality rate of CEA group was higher than that of CAS group within 3 months after operation.There was no statistical difference in the incidence of myocardial infarction between the two groups after one year,and there was no difference in indicators such as restenosis between the two groups.But the cost of hospitalization was lower in the CEA group.Still need more relevant randomized controlled trials to further verify.